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Question: If you come to a scenario being a PCP paramedic uncertified in IV, where when finding and assessing the patient you come to terms that he/she is VSA due to anaphylaxis. Do you have to administer epi, because in the protocol for administering epi on a VSA, it says “in the event anaphylaxis is suspected as the causative event of the cardiac arrest, a single dose of 0.01mg/kg 1:1000 solution, to a maximum of 0.5mg IM, may be give prior to obtaining the IV/IO”. Since it is saying you “may” give it, do you know if you have a choice?

Answer: The PCP Medical Cardiac Arrest Medical Directive states that paramedics are to consider epinephrine (only if anaphylaxis suspected as causative agent) in the dosing you have described above.

The wording however “may be given prior to obtaining the IV/IO” is taken from the ACP Medical Directive and is not present on the PCP Medical Directive. As such, the issue of a PCP waiting for the IV/IO is irrelevant.

As an aside, the conventions of the Medical Directives state, the word “consider” is used repeatedly throughout the medical directives. Where this word appears, it indicates that a paramedic should initiate the treatment unless there is strong clinical rationale to withhold it.